The Sistine Chapel and clothesline signs: a tale of two arteries

An 83-year-old woman presented sudden vertigo, drop attack, and transient dysarthria after head hyperextension to see the Sistine Chapel ceiling, in the Vatican. Transcranial doppler ultrasound suggested proximal basilar stenosis, confirmed by arteriography. Case 2: A 77-year-old woman presented a 1-year history of transient vertigo after hanging clothes on a clothesline. Transcranial doppler ultrasound revealed left subclavian artery steal phenomenon secondary to proximal subclavian artery stenosis, confirmed by arteriography. They received stenting and dual antiplatelet therapy. Transient ischemic symptomatology triggered by head/neck and arm movements demands vertebrobasilar and subclavian evaluation.